幽门螺杆菌感染对免疫检查点抑制剂治疗晚期食管癌患者预后的影响  

Impact of Helicobacter pylori infection on the prognosis of patients with advanced esophageal cancer treated with immune checkpoint inhibitors

作　　者：葛小琴 马瑞爽 谢荣容 陶庆松[1] GE Xiaoqin;MA Ruishuang;XIE Rongrong;TAO Qingsong(Department of Radiotherapy and Chemotherapy,the First Affiliated Hospital of Ningbo University,Ningbo 315000,China)

机构地区：[1]宁波大学附属第一医院放化疗科,315000

出　　处：《浙江医学》2024年第20期2173-2178,共6页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2024KY328)。

摘　　要：目的探讨幽门螺杆菌(Hp)感染对免疫检查点抑制剂(ICI)治疗的晚期食管癌患者预后的影响。方法回顾性选取2021年1月至2023年12月在宁波大学附属第一医院接受ICI治疗的晚期食管癌患者45例,分析患者临床资料,比较14例Hp阳性患者与31例Hp阴性患者疗效,分析影响患者预后的因素。结果Hp阳性患者治疗的客观缓解率(ORR)为35.7%,疾病控制率(DCR)为71.4%;Hp阴性患者的ORR为64.5%,DCR为83.9%。两者ORR、DCR比较差异均无统计学意义(均P>0.05)。与Hp阳性患者相比,Hp阴性患者有更长的中位无进展生存期(PFS)(8.2个月比5.3个月,P<0.05)。多因素Cox回归分析显示,Hp感染状态、美国东部肿瘤协作组(ECOG)评分、联合治疗方案是ICI治疗的晚期食管癌患者PFS的影响因素。Hp阳性相对于Hp阴性HR=2.195(95%CI:1.057~4.556,P<0.05);ECOG评分2分相对于ECOG评分0~1分HR=3.377(95%CI:1.403~8.127,P<0.05);相比于氟尿嘧啶±顺铂治疗方案,紫杉醇±顺铂治疗方案HR=0.237(95%CI:0.098~0.571,P<0.05)。ECOG评分及联合治疗方案亦是ICI治疗的晚期食管癌患者总生存期的影响因素(均P<0.05)。结论Hp对ICI治疗的晚期食管癌的预后影响是多方面的,与Hp阳性患者相比,Hp阴性患者的PFS有延长,总生存期有改善趋势。Objective To explore the impact of Helicobacter pylori(Hp)infection on the prognosis of patients with advanced esophageal cancer treated with immune checkpoint inhibitors(ICI).Methods Clinical data of 45 patients with advanced esophageal cancer who received ICI treatment at the First Affiliated Hospital of Ningbo University from January 2021 to December 2023 were retrospectively analyzed.The efficacy of ICI treatment was compared between Hp-positive patients(n=14)and Hp-negative patients(n=31);and the factors affecting prognosis of patients were analyzed wih multivariate Cox regression.Results There were no significant differences in objective response rate(ORR)and the disease control rate(DCR)between Hp-positive and Hp-negative patients(35.7%vs.71.4%;64.5%vs.83.9%;both P>0.05).Compared with Hp-positive patients,Hp-negative patients had a longer median progression-free survival(PFS)(8.2 months vs.5.3 months,P<0.05).Multivariate Cox regression analysis showed that the status of Hp infection(HR=2.195,95%CI:1.057-4.556,P<0.05),Eastern Cooperative Oncology Group(ECOG)score(HR=3.377,95%CI:1.403-8.127,P<0.05)and combined treatment regimen(HR=0.237,95%CI:0.098-0.571,P<0.05)were factors affecting PFS;and the ECOG score and combined treatment regimen were factors affecting OS in patients with advanced esophageal cancer treated with ICI(all P<0.05).Conclusion Hp infection will affact the prognosis of patients with advanced esophageal cancer treated with ICI along with other factors.Compared with HP-positive patients,HP-negative patients had longer PFS and improved overall survival.

关 键 词：幽门螺杆菌 免疫检查点抑制剂 食管癌 

分 类 号：R735.1[医药卫生—肿瘤]